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Journal of Community and Public
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Health Nur Health Nursing
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ISSN: 2471-9846
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Mini Review
An analysis of the components of a human smile
Kishan Sheth*
Department of Restorative Dentistry, King’s College London BDS5, UK
*Corresponding author: Kishan Sheth, Department of Restorative Dentistry, King’s College London BDS5, UK, Tel: 07903716355; E-mail: Kishan.sheth@kcl.ac.uk
Received date: October 07, 2017; Accepted date: October 31, 2017; Published date: November 07, 2017
Copyright: © 2017 Sheth K. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use,
distribution and reproduction in any medium, provided the original author and source are credited.
The Ideal Smile
Whilst the old saying ‘beauty is in the eye of the beholder’ may be
true, patients are increasingly becoming aware that a powerful smile is
a true asset. But what makes the ‘ideal smile’?
Once I revert to my younger self starting dental school, I could
probably reel off an answer along the lines of ‘well aligned, white and
clean teeth’. However, a definition such as this lacks depth and insight.
Now that I have been through four years of clinical training and
performed procedures such as composite restorations, denture
fabrication and crown/bridge work in the anterior dental aesthetic
zone, I have gained an in depth appreciation of how several factors
must be considered during appraisal of anterior dental aesthetics.
This essay aims to describe the key factors, which must be
considered and assessed when creating the ‘ideal’ smile, such as facial,
gingival and dental aesthetics. It must be remembered that there is
difficulty in defining an ‘ideal’ smile as there is significant variation
between individuals and populations.
As patients have increasing aesthetic demands, it is imperative that
we are understanding their needs, communicating effectively and
delivering on their needs and desires. Every patient that we treat has a
unique set of characteristics, desires and priorities and the
superimposition of a standard, pre-designed ‘ideal’ smile will not be
acceptable. In this regard, it is right of dental professionals to address
dentistry as art as well as science. We should endeavor to provide a
beautiful smile, which matches the patient’s facial form, gingival
architecture and personality. The fundamental principle of smile
design is that the approach employed respects the relation between
hard and soft tissue. I will progress by dividing this essay into
individual components for discussion. However, the end result of any
smile transformation/appreciation will require the blending of all
componentry, rather than analysis of the various factors in isolation
[1].
Lip Architecture
The lips frame the smile and are a site that muscles act upon. It is
therefore important to consider them in static and dynamic phases.
The static position is when the lips are slightly held apart at rest with
perioral muscular activity not employed [2]. On average around
2-4mm of the upper incisors are displayed at rest, but the amount of
incisal show is governed by the lip form (strap like or thicker forms),
patient age, sex or race [3].
The age of the patient can impact the degree of gingival exposure as
aging results in loss of tonicity and elasticity of facial muscles and
collagen fibres. This process results in a reduced amount of maxillary
tooth show and an increase in the amount of mandibular tooth display
[4]. The extent of tooth display during function is characterised by the
J Comm Pub Health Nurs, an open access journal
ISSN:2471-9846
Sheth, J Comm Pub Health Nurs 2017, 3:4
DOI: 10.4172/2471-9846.1000202
Open Access
patient’s skeletal pattern, positioning of the teeth and length/size of the
upper and lower lips [5].
The position of the smile line will affect the characterisation of the
smile. On average, a low smile line only allows for around 30% of
upper central incisal show. A higher smile line/‘gummy smile’ will
allow for up to 2 mm of gingival show in addition to the upper first
incisor [2].
Soft Tissues
Of critical importance is the degree to which the teeth and soft
tissues adapt with each other. Well-pronounced interdental papilla
should be present avoiding the appearance of black triangles/
interdental recession. The gingival margin should coincide with the
enamel-dentine junction on the teeth, only allowing for the anatomical
crown of the teeth to be displayed; root surfaces should not be exposed
[2]. The dental midline should coincide with the facial midline and the
smile should be symmetrical, so as the same teeth are exposed on
either side of the midline and their relative positions on the dental arch
are identical. In reality, only around 70% of the population have
coincident facial and dental midlines. In order to achieve optimal smile
aesthetics, the commissural line (between the corners of the mouth
during smiling), occlusal plane and interpupillary line should all
coincide [6].
The smile arc, that is the semi-circle demonstrated when the upper
incisal edges come into close proximity with the lower lip border in the
posed smile, is an important factor in smile aesthetics. It should not be
over or under pronounced. Through the aging process, the incisal
edges of the maxillary anterior teeth often get flattened and less well
defined through tooth wear or modified tooth eruption results [7].
From an orthodontic viewpoint, the alignment of the maxillary
teeth is more important than that of the mandibular dentition. The
midlines of maxillary and mandibular arches fail to align in around
75% of the US population. The buccal corridor, space between the
lining of the vestibule and the buccal surfaces of posterior teeth, should
be evident so that the teeth are separated from the corners of the
mouth [8].
The gingival architecture forms the soft tissue framework around
each individual tooth. The gingiva should be coral pink in colour and
provide firm texture. The attached gingiva can be either smooth or
stippled in appearance. The gingival tissues play a significant factor in
the appearance and aesthetic value of the smile, especially in high lip
line patients where gingival tissues are exposed to an ever-greater
degree. In the healthy periodontium, the spaces under the contact
areas are filled with healthy interdental papilla, which ensures there are
no black triangles that will compromise the aesthetic power of the
smile.
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Citation: Sheth K (2017) An analysis of the components of a human smile. J Comm Pub Health Nurs 3: 202. doi:10.4172/2471-9846.1000202
Tooth Shape and Colour
Tooth morphology is a fusion of square, oval and triangular shapes,
where square teeth have straight and parallel mesial and distal borders,
oval teeth have curved mesial and distal borders and triangular teeth
have marked line angles and significant degrees of convergence from
incisal to cervical regions [9]. Frush and Fisher’s [10] theory of
morphopsychology placed aesthetic smile design on a rational footing
by suggesting that the shape and form of teeth are linked with a
patient’s age, sex and personality. They described that young patients
will have sharp incisal edges and their upper central incisors will have
more prominence, whereas older patients will have worn-out and
bluntly defined incisal edges. For female patients, a curved and
rounded tooth form would be more appropriate; in the same manner
as clearly defined, sharp, angled tooth forms would suit the male
patient. It is important to understand the nature and personality of the
individual patient when restoring tooth form [11].
Patients are beginning to appreciate the importance of tooth colour
when committing to dental treatment plans. The physical
characteristics of light should be considered when restoring/mimicking
actual tooth structure: factors such as opacity, translucence, reflectance
and fluorescence should all be assessed.
The colour of an individual tooth can be split into three critical
components. Value is defined as the luminosity of the colour/degree of
greyness and is considered to be the most clinically important element
of shade result. The second most important factor is considered to be
chroma: the saturation/dominance of the colour (hue). Hue is defined
as the wavelength of coloured light transmitted as the actual colour of
the tooth and is considered least important due to the relative low
concentrations of hue in actual tooth shade [12]. The shades of
maxillary anterior teeth pass through a slight progression from cervical
margin to incisal edge, as well as from one tooth to the next. Upper
central incisors are known to be the brightest and lightest individual
teeth, which also help them to dominate the smile [13]. The upper
lateral incisors have relatively close hue values to that of the centrals,
but differ in that they have lower value properties. Canines hold the
greatest degree of chroma and have the lowest value properties. The
premolars hold value properties similar to the lateral incisors but will
appear lighter than the canines [14]. When assessing an individual
tooth, the middle third portion of the tooth is generally the brightest,
followed closely by the cervical third portion of the tooth. The incisal
third will hold the least value characteristic due to their higher degree
of absorption of light and higher degree of transparency [15].
Tooth Size, Dimension and Inclination
It is of vital importance to ensure that the teeth are symmetrical and
provide a sense of balance and proportion. The dominance degree of
individual teeth should reduce from the midline moving distally, with
upper central maxillary incisors always having the greatest dominance.
Although it may be tempting to try to think of a ‘magic number’ for
tooth dimensions, in order for the resultant smile to be a success,
individual variation should be introduced to create a more natural
effect. These variations should be subtle and should only be introduced
if they are acceptable to the patient. Sterrett et al. [16] described a
method of determining the average size and proportions of any given
tooth in a smile. The average male tooth is greater in size than that of
the female tooth and gender has very little effect on the crown height:
width ratios and therefore the final dimensions of the tooth. Sterrett et
al. [16] also published that the average maxillary central incisor should
J Comm Pub Health Nurs, an open access journal
ISSN:2471-9846
Page 2 of 3
have a width: length ratio of 0.8, any lower and a tall, narrow tooth
would result, any greater and the result would be a short, stubby tooth.
The central incisor should ideally be around 2 mm wider than the
lateral incisor, which should ideally be 8 mm (length) and 6.3 mm
(width). Average values of the canine tooth are: 9.5 mm (length) and
7.4 mm (width). It should be noted that the maxillary central incisors
and canines ideally would have similar heights of their clinical crowns.
The dental literature refers to the ‘golden proportion’ principle,
which determines the desired widths of the teeth in the anterior
aesthetic zone. A ratio of 1 is given to the maxillary lateral incisor, a
value of 1.6 to the maxillary central incisors and a value of 0.62 to the
maxillary canines [17]. The golden proportion is a principle usually
used for construction, automobiles and objects, but it has some value
in dentistry. Strict adherence should not be encouraged, as some
degree of individual variation is acceptable and more natural looking.
It can, however, be employed as a guidance measure and methodology
when designing a smile.
The long axis of the upper central incisor should be aligned with the
dental midline. The upper lateral incisor should be slightly mesially
tipped towards the midline and the upper canine should be tipped
mesially to an even greater degree, allowing for the achievement of an
aesthetically pleasing smile [2].
The connector rule of 50-40-30 applies in the areas where two teeth
appear to be contacting. The connector space between the upper
centrals should be 50% the length of the upper central crown. In the
same manner, the connector space mesial to the upper lateral should
be 40% of the length of upper lateral crown and mesial to the canine
should be a 30% connector space [18]. The incisal embrasures should
increase in size and volume from midline distally, to give the
impression of sharp and clearly defined teeth [19-21].
Conclusion
Every tooth has its own anatomy and attention should be paid to the
surface texture, colour, tooth form and alignment in the arch. Heavy
surface textures will create multiple zones of reflection and deflection,
creating a youthful appearance.
Society pays more attention to looking and feeling youthful and
patients are starting to desire bright and white smiles. The dental
profession is entrusted with the task of creating beautiful smiles and
whilst the technology/techniques are being continuously developed
and adapted, the basic principles of what constitutes the ‘ideal’ smile,
will likely remain the same. The individual components that have been
discussed need to be integrated together in a holistic approach to
evaluate a smile, accounting for the micro and macro aesthetic
componentry. However, above all, the ‘ideal’ smile in all cases can only
be defined as one which has matched and exceeded both patient and
clinician expectations and desires and an ‘ideal’ smile may somewhat
vary from individual to individual and from population to population.
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Citation: Sheth K (2017) An analysis of the components of a human smile. J Comm Pub Health Nurs 3: 202. doi:10.4172/2471-9846.1000202

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J Comm Pub Health Nurs, an open access journal Volume 3 • Issue 4 • 1000202
ISSN:2471-9846